February 21 – March 2, 2006

HIV/AIDS Prevalence in DRC

The Democratic Republic of the Congo (DRC), with a population of approximately 60 million and an area of 2.4 million square kilometers, is the second largest and fourth most populous country in Africa. Annual per capita income is approximately US$87. In spite of recent economic growth, the country faces steep short-term and medium term socio-economic challenges. The HIV/AIDS epidemic, a major health challenge in itself, compounds the host of other dilemmas facing DRC. The epidemic poses a great public health problem and is a continuing threat to economic recovery and development. Data compiled by the national HIV/AIDS program estimates that as of 2003, about 3 million people live with HIV/AIDS, associated with a prevalence rate among the adult population of just over 5 percent , and provincial variations ranging from 4.5 percent in Kinshasa to 7.5 percent in Lubumbashi. Analysis of data available from case reporting indicates that:

  • The age groups most affected in general are those aged 20 to 49 years, with women aged 20 to 29 years and men aged 30 to 39 years being most affected;
  • Given the incubation period from infection to symptomatic HIV/AIDS, it appears most women are being infected between the ages of 15 and 19, while men are becoming infected between the ages of 20 and 29;
  • Sexual transmission remains the most commonly observed mode of infection accounting for 87 percent of all cases with mother to child transmission accounting for 8 percent of all cases. Approximately 5 percent of cases are related to intravenous transmission resulting from contaminated blood supplies and injection equipment
  • Among high risk groups, infection rates are as high as 33 percent among hospitalized tuberculosis patients and 19 percent among commercial sex workers;
  • Approximately 750,000 children under the age of 15 have lost one or both parents to an AIDS-related illness.

The epidemic in the DRC is further complicated by extreme poverty and weak or nonexistent public health infrastructure. The National AIDS Control Commission (Comite national de lutte contre le SIDA, CNLS) was created in 1987 and developed a short-term plan to assess the scope of the epidemic. Political and civil unrest to date have impeded sustained implementation of prevention efforts.

National Response to HIV/AIDS and the Private Sector

There are multiple ongoing projects in the DRC to address various aspects of the HIV/AIDS epidemic including blood safety, HIV/AIDS awareness and prevention, volunteer counselling and testing and administration of anti-retroviral therapy. These projects are financed through multi-lateral and bilateral aid agencies the most significant programs are currently financed by The World Bank Multi-Country AIDS Program (MAP) and The Global Fund to Fight AIDS, Tuberculosis and Malaria.

On March 17, 2004 the President of the DRC created the Programme National Multisectoriel de Lutte contre le VIH/SIDA, PNMLS (National Multi-Sector Program against HIV/AIDS) The PNMLS is made up of the public sector represented by the Ministry of Public Health, the private and enterprise sectors and the NGO and faith communities in the DRC. The PNMLS is tasked with national coordination of all sectors involved in HIV/AIDS and STI prevention and is assisted in this effort through provincial and local representation. The mission of the PNMSL is to:

  • Create and enforce a national commitment against HIV/AIDS and STIs,
  • Mobilize all social sectors (public, private and civil society) and engage them in effective HIV/AIDS prevention,
  • Request and access international donor assistance, and
  • Implement a national strategy against HIV/AIDS in the DRC.

The goals of the national HIV/AIDS strategy are to:

  • Encourage individuals and communities to adopt safer behaviours toward the prevention of transmission or acquisition of sexually transmitted infections (STIs) and HIV,
  • Promote the correct and consistent use of condoms,
  • Assert effective control over the spread of STIs through standardised testing and syndromic treatment, and
  • Assure care of persons living with HIV.

The National Business Coalition against HIV/AIDS in the DRC, CIELS (The Comite Inter Entreprises de Lutte Contre le VIH/SIA), has recently completed a draft Five Year Plan against HIV/AIDS in the Workforce 2006-2010 (Plan Quinquennal de Lutte Contre Le VIH/SIDA sur le Lieu de Travail 2006-2010). According to the finds of this report, the principal issues regarding HIV/AIDS in the workplace and the current business/enterprise response to the epidemic can be summarized by the following six points:

  • A weak response from the business/enterprise sector (this sector is compromised of private sector, as well as state owned/operated enterprises and mixed public-private ownership),
  • Insufficient resources available for business/enterprise sector to engaged in HIV/AIDS prevention,
  • Lack of standardized approaches and technical orientation to HIV/AIDS interventions in the workplace,
  • The majority of the business/enterprise sector has not effectively integrated HIV/AIDS interventions into the work place,
  • The majority of HIV/AIDS workplace interventions are implemented by external personnel,
  • The business/enterprises sector lacks the capacity to monitor or evaluate the impact of HIV/AIDS on productivity, and
  • Overall, the response has been weak, disregarding the impending impact of HIV/AIDS on the business/enterprise sector specifically, and on economic productivity in general.

Furthermore, while 80 percent of the members of CIELS have workplace programs, most are conducted by untrained personnel and not in adherence to national strategies for HIV/AIDS prevention; 50 percent of businesses/enterprises that have workplace programs distribute condoms, however most condoms are only distributed through the medical services/clinics; and only 56 percent of businesses/enterprises with workplace interventions have behaviour change communication components. Half of the businesses engaged in HIV/AIDS workplace interventions offer volunteer counselling and testing while almost all enterprises offer testing and treatment of sexually transmitted infections (STIs) through their medical clinics.

A study undertaken by the University of Kinshasa School of Public Health in 2005 on the perceptions of and associated cost and consequences of HIV/AIDS on the private/enterprise sector focussed on eight members of CIELS in Kinshasa, (BRALIMA, la Banque Centrale du Congo, FINA Congo, la Societe Nationale d’Electricite (SNEL), la SEP CONGO, l’Office Congolais de Controle, ECC and SHELL CONGO). The study reinforced much of what has been stated in the five year strategy as the principal problems facing HIV/AIDS prevention, care, and treatment in the DRC, and underlined the need for better management and administration of existing services, a heighten awareness within the private/enterprise sector of the consequences of HIV/AIDS, the need for trained peer educators, and a more dynamic response from the Ministry of Health vis-à-vis prevention and workers’ health and healthcare.

Mission Objectives:

The objective of this private sector HIV/AIDS mission was to continue the dialogue with the PMNLS (Programme National Multisectoriel de Lutte contre le SIDA) and private sector stakeholders, including other donors and NGOs, on how to expand partnerships in support of the DRC National Agenda against HIV/AIDS. The discussion included development of national policies and workplace guidelines; the role the business coalition (CIELS) within PNMLS as the primary catalyst for private initiatives; other strategies to engage the private sector; linkage to and leverage of other resources (multi-lateral and bilateral); and exploration of the role of civil society in enhancing public-private partnerships for HIV/AIDS prevention, care and treatment. The mission also initiated discussions concerning the expanded distribution of ARVs and procurement of condoms with appropriate private sector partners.

The mission looked at:

  • Current private sector initiatives to address HIV/AIDS and financial support available from donors/NGOs;
  • Best practices and approaches currently underway;
  • Information on the current legal framework relating to employer social responsibility (and planned legislation);
  • The capacity of the PNMLS and CIELS (Comité Intra-Entreprises pour la Lutte contre le SIDA), the Congolese Business Coalition against HIV/AIDS, to work with the private sector at the national, provincial and community levels;
  • Mechanisms to enhance private sector engagement, including application forms, eligibility criteria, eligible expenditures, unit costs, review process, monitoring and evaluation (M&E);
  • Strategies for scaling up private sector involvement in the national response to HIV/AIDS including linkage to other donor programs and civil society; and
  • 2006 PNMLS private sector and CIELS action plans and budget to enable effective implementation of the private sector strategy.

In addition, we were asked to:

  • Review organizational capacity of CIELS and made recommendations for specific training as well as the hiring of an international consultant to assist in organizational management, as agreed in 2005; and
  • Review strategies to better engage the mining, transport and forestry sectors in the fight against HIV/AIDS (including a review of the USAID/GDA strategy for engaging the mining sector in Katanga and crafting a strategy for engaging the private sector in Mbuji-Mayi)

Results:

Proposal Process and Funding

  • The mission and PNMLS reviewed the procedural mechanisms for the private sector component of the MAP including the PNMLS private sector manual, application form, evaluation criteria, eligibility criteria, and indicators. The private sector manual is well done and comprehensive with the exception of the need to define second tranche mechanisms (i.e., how do they get the second tranche) and some inconsistencies in the 2006 costing table. Currently, PNMLS, AGF (the designated financial management agent) and the World Bank are in discussions regarding development of more accurate cost unit table, simplified process and possible new procurement guidelines.
  • A revised proposal review process has been developed by the PNMLS private sector focal point and is awaiting review and approval by the PNMLS M&E focal point and AGF. The new process would reduce the number of people doing the review to three, resulting in a shorter time required for project review and approval. (See the Private Sector Access to Financing Guide)
  • In 2005, twenty private sector projects were funded for four months, inclusive of major industries, federations, unions and SMEs. These projects are currently awaiting second tranche funding to cover the remaining eight month period.
  • Issues associated with monitoring and evaluation and financial reporting are delaying second tranche funding and project implementation; issues included inconsistent application of the reporting matrix and inaccurate or incomplete reporting forms and difficulty in assessing project impact and technical viability.
  • 30 projects have been submitted for approval and funding in 2006. Budget requests range from $150,000 to over one million dollars. Format issues remain.

Project Financing and Implementation

  • Several 2005 projects were not submitted on time and are now awaiting review for 2006 funding.
  • 2006 funding has not yet been disbursed to the PNMLS, as it is awaiting budget finalization and approval.
  • Project-wide questions exist with the management and functioning of the AGF and accurate unit cost calculations and reporting.
  • Delay in initial project financing and implementation were most frequently caused by initial difficulties in establishing individual bank accounts for private sector companies and the unbudgeted high cost associated with maintaining these bank accounts.
  • Limited M&E capacity within private sector projects hindered the assessment of project/ activity impact.

Business Coalition (CIELS)

  • The CIELS project proposal is still under development. The primary obstacle to proposal approval is a more realistic scope of work and budget. We anticipate final proposal by March, 2006. (It should be noted that the proposal has been in development for five months.)
  • CIELS has completed all recommended tasks for 2005.
  • Elections have taken place and CIELS operational structures are in place with managing director, administration, M&E and finance officers. Overall functioning of CIELS has advanced considerably including regular monthly meetings reviewing private sector activities – funded and un-funded.
  • Membership has increased to over thirty members and a membership fee has been established ($1500 for large companies and $600 for SMEs and partners) with approximately $35,000 out of $63,000 collected. Fees currently apply to CIELS members in Kinshasa (at the national level) only.
  • Membership is diverse, including private sector, parastatals, unions and federations, representing large industry as well as SMEs. Partners include NGOs and donor agencies.
  • CIELS remains in a nascent stage requiring ongoing support for capacity building in M&E, financial management and member services in support of private sector integration into the national HIV/AIDS program.
  • At the provincial level CIELS is beginning to establish a presence with a volunteer staff.
  • Given elevated rates of HIV and higher-risk enterprise environments around mining, transportation, and forestry in the provinces, a more active CIELS is essential.
  • Potential links to other donor activities in the provinces may provide CIELS with the needed support (e.g. USAID/GDA mining sector partnership project).

National Legislation: Article 34 has been added to the Convention Collective Interprofessionnelle Nationale du Travail, which encourages the creation of committees against HIV/AIDS within all companies operating in the DRC. The article also states that these committees should be responsible for developing and implementing a workplace policy to fight against HIV/AIDS and mitigate discrimination against Persons Living with HIV/AIDS within individual enterprises and/or federations and unions. There is now a clear mandate for the PNMLS, FEC and ILO to work together to encourage the development of a national workplace policy for HIV/AIDS.

High-risk Private Sector Environments: The identification of strategies to ensure access to HIV/AIDS services in high-risk environments, including forestry, mining and transportation, has begun and the 2006 PNMLS private sector work plan further articulates strategies to reach these sectors. (See PNMLS private sector action plan and the USAID GDA partnership in Katanga).

Mbuji-Mayi Strategy: The PNMLS private sector focal point will work with MIBA to develop a comprehensive proposal for MAP funding to address high risk mining and transportation environments in the region. He will also investigate the possibility of collaboration with existing NGO services in the region and linking to donor activities (USAID GDA and GTZ). The private sector focal point also plans to work closely with Féderation Congolaise de l’Or et du Diamant to refine their MAP proposal for Kasai Oriental province.

Communication Strategy: A comprehensive draft guide exists to communicate MAP submission procedures; however several additions are required including guidance on determining accurate unit costs and clarification of an expedited process for second tranche funding. The final document should be completed by March 31, 2006.

The CIELS monthly meetings in Kinshasa provide an opportunity for sharing project information and discussion of implementation and financing barriers as well as best practices. At the provincial level however, there are currently limited opportunities to exchange information, as CIELS infrastructure is far less developed; as capacity increases at the provincial level, monthly meetings should be established to communicate project activities and standardize this communication process throughout the CIELS system.

Next steps:

A follow-up mission will be conducted.

 
CCA's HIV/AIDS Initiative
 


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